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July 22, 2023

10 Most Common Sleep Apnea Secondary Conditions (The Ultimate Guide)

Last updated on May 9, 2024

I hope you enjoy reading this blog post.

If you want to learn how to implement these strategies to get the VA benefits you deserve, click here to speak with a VA claim expert for free.

This post is your ultimate guide to the 10 most likely Sleep Apnea Secondary Conditions for VA disability benefits.

In our experience, most veterans are better off trying to service-connect Sleep Apnea secondary vs. direct, especially if they weren’t diagnosed with sleep apnea until after leaving the military.

Pro Tip: You’ll need a Nexus Letter to connect Sleep Apnea as a secondary claim. We also recommend you have a private healthcare provider complete a DBQ for Sleep Apnea and submit it and your Nexus Letter with your Fully Developed Claim (FDC).

Are there VA Secondary Conditions to Sleep Apnea?

VA Secondary Conditions to Sleep Apnea

Yes, according to medical research and the 25,000+ veterans we’ve helped since 2016, here’s a list of the 10 most common conditions for Sleep Apnea as a secondary VA claim (listed in alphabetical order):

  • Sleep Apnea secondary to Asthma
  • Sleep Apnea secondary to Deviated Septum
  • Sleep Apnea secondary to Medications
  • Sleep Apnea secondary to Rhinitis
  • Sleep Apnea secondary to Sinusitis

Top 10 Sleep Apnea Secondary Conditions

Top 10 Sleep Apnea Secondary Conditions

#1. Sleep Apnea secondary to Anxiety

Yes, sleep apnea and anxiety can be related, and there is evidence to suggest that anxiety can contribute to the development or exacerbation of sleep apnea and vice versa.

Generally, the more severe the anxiety the more severe the sleep apnea.

The connection between anxiety and sleep apnea lies in their effects on the body.

  • Muscle Tension: Anxiety can cause muscle tension, including the muscles in the throat. Tense throat muscles may narrow the airway, making it more susceptible to collapse during sleep, which can contribute to or worsen obstructive sleep apnea.
  • Increased Arousal: Anxiety triggers the body’s “fight-or-flight” response, leading to increased arousal and heightened vigilance. This state of hyperarousal can interfere with the normal sleep cycle, making it harder to achieve restful sleep and potentially contributing to sleep apnea episodes.
  • Sleep Disruptions: Anxiety can lead to frequent awakenings during the night or difficulty falling asleep. Sleep disruptions can affect the overall quality of sleep and may exacerbate existing sleep apnea conditions.
  • Stress Hormones: Anxiety triggers the release of stress hormones like cortisol, which can influence sleep patterns and may contribute to sleep apnea-related problems.

#2. Sleep Apnea secondary to Asthma

There is evidence to suggest that asthma and sleep apnea can be related, with one condition potentially exacerbating the other in a bidirectional relationship.  

The relationship between asthma and sleep apnea can work in the following ways:

  • Asthma Exacerbating Sleep Apnea: Asthma symptoms, particularly nighttime symptoms like coughing and wheezing, can disrupt sleep and increase the risk of developing sleep apnea. Inflammation and narrowing of the airways can make it more challenging for individuals with asthma to maintain regular breathing patterns during sleep, potentially contributing to sleep apnea episodes.
  • Sleep Apnea Exacerbating Asthma: Sleep apnea, especially OSA, can lead to decreased oxygen levels in the blood and increased carbon dioxide levels. These changes can trigger asthma symptoms or worsen existing asthma, as low oxygen levels and increased carbon dioxide can cause airway inflammation and bronchoconstriction.

#3. Sleep Apnea secondary to Depression

Medical research suggests a bidirectional relationship between sleep apnea and depression, with one condition potentially exacerbating the other—the more severe the depression the more severe the sleep apnea.

The relationship between depression and sleep apnea can work in the following ways:

  • Depression Exacerbating Sleep Apnea: Depression can lead to changes in sleep patterns, such as difficulty falling asleep, waking up too early, or experiencing fragmented sleep. These disruptions in sleep can contribute to the development or worsening of sleep apnea. Additionally, some individuals with depression may engage in behaviors, such as weight gain or a sedentary lifestyle, that can increase the risk of developing obstructive sleep apnea.
  • Sleep Apnea Exacerbating Depression: Sleep apnea, particularly OSA, can lead to sleep disruptions and decreased oxygen levels during sleep. These physiological changes can impact mood and exacerbate symptoms of depression. Additionally, chronic sleep deprivation caused by sleep apnea can lead to daytime fatigue, irritability, and cognitive impairment, which may worsen depressive symptoms.

#4. Sleep Apnea secondary to Deviated Septum

Yes, there is a strong connection between sleep apnea and a deviated septum.

A deviated septum refers to the condition where the thin wall (nasal septum) that separates the two nostrils is shifted to one side, causing one nasal passage to be smaller than the other.

This can lead to various breathing difficulties and potentially contribute to sleep apnea.

The relationship between sleep apnea and a deviated septum works as follows:

  • Nasal Obstruction: A deviated septum can create nasal airway obstruction, making it more difficult for air to pass through the nose during breathing. This can result in mouth breathing during sleep, which can contribute to or exacerbate obstructive sleep apnea (OSA). OSA occurs when the throat muscles relax excessively during sleep, leading to a blocked airway.
  • Sleep Disruptions: Nasal congestion and difficulty breathing through the nose can lead to sleep disruptions. If a person is unable to breathe efficiently through their nose, they may experience frequent awakenings during the night, affecting the overall quality of sleep.
  • Sleep Apnea Aggravating Nasal Problems: On the other hand, sleep apnea, especially OSA, can lead to negative pressure within the upper airway during sleep, causing the tissues to collapse and further obstruct the nasal passages. This can worsen pre-existing nasal problems, including a deviated septum, and may make it more challenging to breathe through the nose during waking hours.

#5. Sleep Apnea secondary GERD

Yes, there is evidence to suggest that there may be a relationship between sleep apnea and gastroesophageal reflux disease (GERD), with one condition potentially influencing the other.

The relationship between sleep apnea and GERD can work in the following ways:

  • GERD Worsening Sleep Apnea: GERD symptoms, such as heartburn and regurgitation, can disrupt sleep and lead to frequent awakenings during the night. These sleep disruptions may contribute to or worsen sleep apnea, particularly obstructive sleep apnea (OSA).
  • Sleep Apnea Worsening GERD: Sleep apnea, especially OSA, can create negative pressure within the chest and abdomen during breathing pauses, potentially leading to an increase in acid reflux episodes. The increased intra-abdominal pressure during obstructive events can force stomach acid up into the esophagus, worsening GERD symptoms.

#6. Sleep Apnea secondary to Medications

Yes, certain medications have been associated with an increased risk of sleep apnea or exacerbating existing sleep apnea in some individuals.

Sleep apnea secondary to medications is more commonly observed with medications that affect respiratory function, central nervous system function, or muscle tone.

These medications can potentially contribute to sleep apnea through various mechanisms:

  • Central Nervous System (CNS) Depressants: Medications that act as CNS depressants, such as opioids, benzodiazepines, and sedative-hypnotics, can relax the muscles in the throat and respiratory system, leading to an increased risk of obstructive sleep apnea (OSA).
  • Muscle Relaxants: Medications used as muscle relaxants, like baclofen or certain antispasmodics, can decrease muscle tone, including the muscles that keep the airway open. This relaxation of muscles may contribute to the collapse of the upper airway during sleep, leading to OSA.
  • Antidepressants: Some antidepressants, especially those that increase serotonin levels (e.g., selective serotonin reuptake inhibitors or SSRIs), may affect the respiratory drive and potentially lead to central sleep apnea (CSA).
  • Antipsychotics: Certain antipsychotic medications have been associated with sleep-disordered breathing, including sleep apnea, due to their impact on respiratory control mechanisms.
  • Hormone Therapy: Hormone replacement therapy or hormonal medications, particularly in menopausal women, can sometimes affect sleep patterns and contribute to sleep apnea.
  • Other Medications: Other medications, such as antihistamines (commonly found in allergy or cold medications), can cause relaxation of the muscles in the throat and contribute to OSA.

#7. Sleep Apnea secondary to PTSD

Yes, Sleep Apnea can be connected secondary to PTSD.

There are several peer-reviewed scientific studies showing a connection between PTSD and Sleep Apnea, particularly Obstructive Sleep Apnea (OSA).

There is also a bidirectional relationship between PTSD and OSA, meaning the more severe the PTSD the more severe the OSA and vice versa.

PTSD itself leads to a disrupted sleep architecture, promotes sleep disordered breathing, and causes neurophysiological changes within the body.

Second, even if a veteran has weight gain/ obesity, progressive weight gain can play a role in the development of OSA, which is made worse or aggravated by PTSD symptoms.

Finally, PTSD causes nightmares and disorder breathing during sleep and having PTSD can lead to physiological changes in a veteran that develops OSA.

The relationship between sleep apnea and PTSD can work in the following ways:

  • Sleep Disruptions: PTSD can lead to frequent awakenings during the night due to nightmares or intrusive thoughts, disrupting the normal sleep cycle. These sleep disturbances can impact the overall quality of sleep and may contribute to the development or worsening of sleep apnea.
  • Hyperarousal and Muscle Tension: Individuals with PTSD often experience hyperarousal, a state of heightened alertness and increased physiological activity. This state of hyperarousal can lead to muscle tension, including the muscles in the throat, which may narrow the airway and increase the risk of obstructive sleep apnea.
  • Overlapping Risk Factors: Both sleep apnea and PTSD share certain risk factors, such as obesity and stress. These shared risk factors may contribute to the co-occurrence of both conditions in some individuals.

#8. Sleep Apnea secondary to Rhinitis

Yes, there is a connection between sleep apnea and rhinitis, particularly in cases of chronic nasal obstruction.

When rhinitis causes chronic nasal congestion, it can contribute to or exacerbate sleep apnea as follows:

  • Nasal Obstruction: Chronic rhinitis and nasal congestion can lead to partial or complete nasal obstruction. When the nasal passages are blocked, individuals may find it difficult to breathe through their nose during sleep, and as a result, they may resort to breathing through their mouth. Mouth breathing can increase the likelihood of developing or worsening obstructive sleep apnea (OSA) because it allows the soft tissues in the throat to collapse more easily during sleep, leading to airway obstruction.
  • Sleep Disruptions: Nasal congestion and difficulty breathing through the nose can cause sleep disruptions. People with rhinitis may experience frequent awakenings during the night due to discomfort or the need to clear their airway. These sleep disruptions can affect the overall quality of sleep and may contribute to sleep apnea.
  • Negative Pressure in the Airways: In some cases, the negative pressure generated in the airways during sleep apnea events (e.g., during obstructive episodes) can worsen rhinitis symptoms by pulling more blood into the nasal tissues, causing them to swell further.

#9. Sleep Apnea secondary to Sinusitis

Yes, there can be a connection between sleep apnea and sinusitis, particularly when sinusitis leads to nasal congestion and obstruction.

Sinusitis is an inflammation or infection of the sinuses, which are air-filled cavities located around the nose and eyes.

When sinusitis causes chronic nasal congestion, it can contribute to or exacerbate sleep apnea as follows:

  • Nasal Obstruction: Chronic sinusitis and nasal congestion can lead to partial or complete nasal obstruction. When the nasal passages are blocked, individuals may find it difficult to breathe through their nose during sleep and may resort to breathing through their mouth. Mouth breathing can increase the likelihood of developing or worsening obstructive sleep apnea (OSA) because it allows the soft tissues in the throat to collapse more easily during sleep, leading to airway obstruction.
  • Sleep Disruptions: Nasal congestion and difficulty breathing through the nose can cause sleep disruptions. People with sinusitis may experience frequent awakenings during the night due to discomfort or the need to clear their airway. These sleep disruptions can affect the overall quality of sleep and may contribute to sleep apnea.
  • Negative Pressure in the Airways: In some cases, the negative pressure generated in the airways during sleep apnea events (e.g., during obstructive episodes) can worsen sinusitis symptoms by pulling more blood into the nasal tissues, causing them to swell further.

Yes, there is a well-established connection between weight gain and sleep apnea.

Weight gain, particularly excess body weight and obesity, is one of the most significant risk factors for developing obstructive sleep apnea (OSA).

Here’s how weight gain can lead to sleep apnea:

  • Upper Airway Obstruction: Excess body weight, especially fat deposits in the upper airway and neck, can narrow the airway. When a person with excess weight lies down during sleep, the soft tissues in the throat can collapse more easily, leading to a blocked airway and obstructive sleep apnea (OSA).
  • Reduced Muscle Tone: Obesity can also lead to decreased muscle tone, including the muscles in the upper airway. Weakened muscles are more prone to collapse during sleep, contributing to the obstruction of the airway.
  • Increased Inflammation: Obesity is associated with increased inflammation in the body, including inflammation in the upper airway. Inflammation can further narrow the airway and exacerbate sleep apnea.
  • Hormonal Changes: Weight gain and obesity can lead to hormonal changes, such as insulin resistance and alterations in leptin and ghrelin levels. These changes can affect the regulation of breathing and may contribute to sleep apnea.

Weight loss is often recommended as a primary treatment for individuals with obesity-related sleep apnea.

Losing weight can help reduce the amount of fat surrounding the upper airway and improve muscle tone, leading to a less obstructed airway during sleep.

Need a Nexus Letter for Sleep Apnea Secondary?

Trying to get a Nexus Letter to connect Sleep Apnea as a secondary condition?

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About the Author

Brian Reese
Brian Reese

Brian Reese

Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).

Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start. 

As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.

He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

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